Table Of Contents

Peripheral Artery Disease (PAD)

Watch ▶Peripheral artery disease: Pathology review

Watch ▶Peripheral arterial disease and ulcers: Clinical sciences

General

• Atherosclerosis affecting peripheral vessels, primarily in the lower extremities.

Risk Factors

• Smoking (1#)
• Hypertension
• hyperlipidemia
• Diabetes mellitus
• Chronic kidney disease (CKD)
• History of coronary artery disease (CAD).

Localization of arterial occlusion in PAD

Clinical Features

• Claudication
  • Initial symptom, pain induced by walking and relieved by rest.
  • Quadriceps, calves, and gluteal muscle groups are commonly involved.
• Severe Symptoms
  • Rest pain
  • Cyanosis (purple/blue discoloration)
  • Hairless legs, skin ulcers, shiny skin, muscle atrophy
• Buerger's Sign
  • Foot elevation turns foot pale, then dangling (lowering) foot turns it bright red.

• Buerger test / sign

Dry gangrene in peripheral arterial disease

• Details

Diagnosis

• ABI

  • Normal ratio is 0.9-1.3
  • An ABI ≤ 0.9 indicates abnormality.
  • Can add exercise to test if equivocal

  <aside> 💡 Elevated values > 1.3 can be seen with calcified vessels

  </aside>

• Imaging

  • Ultrasound, CT angiography, or MRI angiography for visualization.

ABI

Management

<aside> 🚨

Patients with PAD and intermittent claudication have an estimated 20% 5-year risk of non-fatal MI and stoke and a 15-30% risk of death due to cardiovascular causes.

</aside>

• Supervised Graded Exercise Therapy (First-line)
  • Improves claudication.
  • Augments formation of collaterals
• Smoking cessation.
• Medical Therapy
  • Antiplatelets (e.g., aspirin, clopidogrel)
  • Statins
• Cilostazol
  • Improves claudication symptoms refractory to exercise.
• Revascularization
  • Surgical bypass or endovascular stenting
  • Indications
    • Lifestyle-limiting claudication despite optimal medical therapy and exercise
    • limb-threatening ischemia (CLI) or ABI <0,4

<aside> 💡 Only ASA, Statins and smoking cessation decrease mortality.

</aside>

• UWT - ABI

Mimics of Arterial Occlusion

This is just to keep them in mind, they will be disscussed in thier respective chapters